Donor Lymphocyte Infusion Safe, Effective for Patients Who Relapse Post-Transplant

A study by the Japan Marrow Donor Program found that unrelated donor lymphocyte infusion (UDLI) led to a 57 percent complete response rate in patients with a hematologic malignancy who had a molecular/cytogenetic relapse following an allogeneic hematopoietic cell transplantation (AHCT).

Researchers, led by Toshiro Miyamoto, MD, PhD, of the Medical Committee of the Japan Marrow Donor program, evaluated the safety and efficacy of UDLI in 414 patients who had the following malignancy types:

  • acute myeloid leukemia (n=184)
  • myelodysplastic syndromes (n=69)
  • acute lymphocytic leukemia (n=57)
  • chronic myeloid leukemia (CML, n=36),
  • lymphoid neoplasms (n=38)
  • adult T-cell leukemia/lymphoma (n=18)
  • multiple myeloma (n=12)

Sixty-five patients (16%) were in cytogenetic/molecular relapse and 349 (84%) were in hematologic relapse following AHCT. Median time between AHCT and UDLI was 244 days.

After 100 days of follow-up, complete response rates were 57 percent (n=37) in the cytogenetic/molecular relapse group and 20 percent (n=69) in the hematologic relapse group (p<0.001 for both). Sixty percent of patients (n=247) were alive at 100 days; the most common cause of death was disease progression (n=110; 26%), followed by infection (n=26; 6%), graft-versus-host disease (GVHD; n=12; 3%), and organ failure (n=13; 3%).

Dr. Miyamoto and co-authors also conducted a multivariate analysis to determine factors associated with response and found that molecular/cytogenetic relapse, presence of GVHD post-ULDI, and CML were significant prognostic factors (p values not provided). “These results indicate that UDLI may have efficacy in relapsed patients with CML, low tumor burden, or occurrence of GVHD post-UDLI,” the authors concluded, noting that the study’s findings are limited by its retrospective design.

Source: Miyamoto T, Fukuda T, Nakashima M, et al. Donor lymphocyte infusion for relapsed hematological malignancies after unrelated allogeneic bone marrow transplantation facilitated by the japan marrow donor program. Biol Blood Marrow Transplant. 2017 February 21. [Epub ahead of print]